Biological Solutions to Anatomical Acromioclavicular Joint Reconstruction

Acromioclavicular (AC) joint injuries are frequent injuries in athletes, typically resulting from a fall onto the lateral aspect of the acromion with the arm in an adducted position. AC joint stability depends primarily on the AC and coracoclavicular (CC) ligaments. Treatment is typically nonoperative for types I and II injuries and operative for types IV, V, and VI injuries. Type III injuries involve disruption of both the AC and CC ligaments, and controversy surrounds the indications for nonoperative vs operative treatment for these injuries. Multiple surgical options have been described for AC instability, including CC screw fixation, coracoacromial ligament transfer, and numerous methods of anatomical CC ligament reconstruction. CC ligament reconstruction can be performed either open or arthroscopically, with various combinations of allograft, autograft, synthetic ligaments, and suture materials. The purpose of this review is to discuss biological solutions to anatomical CC ligament reconstruction. In addition, the authorsʼ preferred techniques for biological AC reconstruction have been discussed.